P0323 - Wide Variation in Neoplasia Detection Rates in Barrett’s Esophagus (BE): A Population-Based Analysis Using the GIQuIC National Quality Benchmarking Registry

Sachin Wani, MD¹, J. Lucas Williams, MPH², Jennifer Holub, MPH², Christian Davis, MD³, Jennifer Kolb, MD, MS⁴, Nicholas Shaheen, MD^5
1University of Colorado Anschutz Medical Campus, Aurora, CO; ²GI Quality Improvement Consortium, Bethesda, MD; ³University of Colorado School of Medicine, Denver, CO; ⁴University of California Irvine, Orange, CA; ⁵University of North Carolina at Chapel Hill, Chapel Hill, NC

Introduction: Analogous to adenoma detection rate, neoplasia detection rate (NDR) defined as the prevalence of high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) on screening or surveillance examination among BE patients, has been proposed as a quality benchmark. However, population-based data assessing variability in NDR are not available. Using a national registry with matched endoscopy and pathology data, we evaluated NDR across a large group of endoscopists in multiple endoscopy centers.

Methods: We analyzed data from the GI Quality Improvement Consortium (GIQuIC) Registry, a national repository of endoscopy data. Upper endoscopy data on patients with suspected or established BE that included procedure indication, demographics, endoscopy findings, and pathology results were assessed from 1/2018 – 5/2021. Endoscopists and sites had to have submitted at least 10 and 20 EGDs records with suspected/established BE, respectively to be included. Adherence to Seattle protocol was assessed by dividing the BE length by number of pathology jars; a ratio of ≤2.0 with rounding down was considered adherent. The primary outcome was NDR by endoscopists. Secondary outcome included NDR by center, and detection rate of any dysplasia/EAC by endoscopists and center.

Results: Of 415,883 EGDs assessed, 20,155 (4.8%) met inclusion criteria [mean age 62.5 yrs (SD 12.7), 61.3% male, 91.5% Caucasian, mean BE length 2.3 (SD 2.8)]. These cases represented 255 practices and 1195 endoscopists nationwide. The distribution of endoscopists based on US census region was: South (n=436, 36.5%), West (n=329, 27.5%), Northeast (n=266, 22.3%), Midwest (n=163, 13.6%). The overall adherence to the Seattle protocol was 86.1%. Overall NDR was 1.0% (209/20,155), any dysplasia/EAC 3.4% and based on EGD volume highlighted in Table. NDR varied significantly among endoscopists [mean NDR: 1.2% (SD 2.6); any dysplasia/EAC: 3.7% (SD 5.5)] and participating sites [mean NDR: 1.3% (SD 1.8), any dysplasia/EAC: 3.7% (SD 3.8)] (Figure). Endoscopists with adherence rate to Seattle protocol of ≥90% had lower NDR (0.94% vs. 1.52%, p=0.009) and any dysplasia/EAC rate (3.3% vs. 4.3%, p=0.03) compared to those with < 90% adherence rates.

Discussion: This is the first US population-based study to report NDR across multiple endoscopy centers. NDR is lower than previously reported with significant variation among endoscopists. Future studies should determine whether educational interventions can improve NDR and EAC related outcomes such as interval EAC.




Disclosures:


Sachin Wani, MD¹, J. Lucas Williams, MPH², Jennifer Holub, MPH², Christian Davis, MD³, Jennifer Kolb, MD, MS⁴, Nicholas Shaheen, MD⁵. P0323 - Wide Variation in Neoplasia Detection Rates in Barrett’s Esophagus (BE): A Population-Based Analysis Using the GIQuIC National Quality Benchmarking Registry, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.